Patient: I have suffered from chronic gastritis and chronic cholecystitis for many years, with occasional hiccups, reflux and heartburn. 2006 began to gradually worsen, sometimes with pain behind the sternum, aggravated by lying down, increased hiccups and reflux, and sometimes choking with reflux when sleeping at night. October 2007 gastroscopy at the Second Hospital of Xinjiang Autonomous Region diagnosed 1, chronic atrophic gastritis, 2, Barrett’s esophagus (one on the right). In July 2008, the second gastroscopy at the Second Hospital of Xinjiang Autonomous Region diagnosed: 1) chronic atrophic gastritis, 2) Barrett’s esophagus (one on the right side), and 3) reflux esophagitis. After the examination in October 2007, he took lansoprazole and vincristine orally for three months, and Chinese medicine tonics for more than three months. After treatment, he improved, but after stopping the medication, he relapsed and developed pain behind his sternum when he choked and swallowed. In July 2008, I was hospitalized after a review: 1) Barrett’s esophagus APC treatment, 2) reflux esophagitis: PH test was done to diagnose severe gastric acidity, and acid suppression treatment was performed. After discharge from the hospital, take medication as prescribed by the doctor: 1, trimebutine maleate capsule 2, magnesium aluminum carbonate tablet 3, sodium rabeprazole enteric solution 4, pancreatic enzyme enteric solution capsule 5, morpholine or moxaburi. A total of eight weeks to take the treatment is not effective, and Chinese medicine and tonics for more than three months to improve, and a month after stopping the drug relapsed, now with Loxacol and gold Sanqi capsule has taken five months to reduce stomach acid, but other effects are not obvious. The main symptoms are: burning and pain behind the sternum sometimes radiating to the back, aggravated by lying down, hiccups after meals, bloating, reflux, sometimes vomiting, choking on food, and difficulty swallowing. What treatment should I get according to my current condition, please give me guidance? Chen Guirong, Department of Gastroenterology, General Hospital of Jinan Military Region
Chen Guirong, Department of Gastroenterology, General Hospital of Jinan Military Region: It is recommended (for reference only) to agree with the diagnosis of “reflux esophagitis, Barrett’s esophagus” made by your local hospital, but the pathological diagnosis of “atrophic gastritis” is not seen. However, the pathological diagnosis of “atrophic gastritis” was not seen. The treatment measures of your local hospital were correct. It is just that the disease requires longer treatment. You should pay attention to your life and not eat very much at each meal. When eating, do not sit curled up after eating, to Shen straight waist, etc., f prevent gastric reflux. In addition whether there is a hiatal hernia, but not cardia failure, the 2 symptoms are completely different, the latter is obstructive symptoms.
Patient: Can esophageal hiatal hernia be diagnosed by gastroscopy? Some information says that reflux esophagitis can be treated surgically. If so, what kind of surgery should be done?
Chen Guirong, Department of Gastroenterology, General Hospital of Jinan Military Region: The endoscopic manifestation of esophageal hiatal hernia: the hernial sac can be diagnosed when the cardia dentate line moves up, or the hernial sac can be seen under the dentate line, or when the cardia cannot be wrapped around the gastroscope or the hernial sac can be seen during gastroscopic reversal examination. Reflux esophagitis, usually without surgical treatment. Esophageal hiatal hernia can be considered in severe cases, and there is now an endoscopic suture method. Beijing 301 Hospital carries out early. It is relatively well done. But the long-term results are not very satisfactory.
Patient: Please ask the expert to give some advice on medication
Chen Guirong, Department of Gastroenterology, General Hospital of Jinan Military Region: It is recommended to use: omeprazole (Loxac) capsule/enteric tablet; or esomeprazole magnesium (Nexium) enteric tablet; or rabeprazole sodium (Repo) enteric tablet. Take 1 tablet/capsule orally 1-2 times daily. Morpholine can be added. The above is for reference only.